INCORRECT TIN# FILED FOR A CAPITATED CARRIER

DESCRIPTION OF THE ISSUE
The claims of Wellcare were initially denied for “No Authorization on file”. {submitted with the Tax-Id# 123456789}.

CONCEPT
If a provider is capitated under a plan, we need to verify on all the information of the provider with the concerned Insurance records to avoid denials of missing/incorrect provider’s information.

SOLUTION
Upon verification with Wellcare we found Dr.  had separate Tax-Id# 987654321 and was capitated with this plan. Hence all the claims were refiled and processed under capitation

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